Feeding the patient-1.pptx

a nursing procedure about how to feed an unconcious patient

1. Feeding of the patient BY Aminu Muhammad Hussain

2. Patients admitted to hospital generally have nutritional needs that must be met by the nurses. They often have higher energy needs or small appetites than healthy people and many patients entering hospital have already lost weight due to their illness.

3. Purpose To assist the patient to eat meal To meet the nutritional need To promote health To prevent dehydration To improve appetite

4. Indications Head and neck cancer. Dysphagia Inflammatory bowel disease Trauma Psychotic illness Elderly Pediatric (malnourished)

5. Types of feeding Enteral The term, enteral, refers to nutrition administered via the gastrointestinal tract. It may be administered orally or via tube feeding. Oral Oral nutritional supplements (ONS) are nutrition support products that provide an effective and non-invasive way for people to meet their nutrition needs or increase their nutritional intake. Tube Feeding If a person has a condition or illness which limits or impairs oral intake, enteral nutrition (EN) therapy can be administered directly into the gastrointestinal tract as a tube feeding . Enteral nutrition via tube feeding provides life sustaining nutrients

6. Cont. Parenteral Parenteral nutrition (PN) is the intravenous administration (feeding into a vein) of nutrients directly into the systemic circulation, bypassing the gastrointestinal tract. It is a special liquid mixture containing protein, carbohydrates, fats, vitamins , minerals, and other nutrients needed to live . PN represents an alternative or additional approach for nutrition intervention when nutrition needs cannot be met from the oral or enteral routes alone, or are contraindicated .

7. Requirement A tray containing: A glass of water to give at the end of the meal Napkin to wipe the face in between Mackintosh and towel Feeding cup or spoon and fork The required amount of feed in a mug at the right temperature Kidney tray

8. Principles The diet is prescribed by doctor planned by dietician and prepared by nurse Food should be prepared at correct time in a pleasant manner and in a pleasant atmosphere Small and frequent meals are preferable for a sick person Maintain a chart for intake of food and fluids for seriously ill patients. The patient should be free from pain and other discomfort during meal time Food should be prepared in an attractive manner so that the sight and smell of should increase his appetite Food should not be too hot or too cold

9. Cont. Ensure privacy Meals should be prepared in clean and covered vessels Give enough time for the patient to enjoy his food Encourage the patient to develop a taste to his therapeutic regimen of diet Be careful not to spill food. Wipe the patient’s mouth and chin whenever necessary Wash patient’s hand and make him brush his teeth after meals

10. Procedure Wash hands thoroughly Make sure that patient is not starving Explain procedure to patient Make sure that therapeutic restriction are considered Cover patient below chin with face towel Feed the patient either by using spoon or fingers Offer water as required After meal, give water to rinse mouth and spit into basin or bowl Complete feed and wipe mouth Record the procedure in the nurse record sheet and intake output chart

11. After the procedure Help the patient to wash his mouth and hands Remove towel around the neck Make the patient comfortable Take all the articles to utility room discard the waste, clean the articles and replace it Record the procedure in the nurse’s record sheet and intake output chart

12. Tube feeding Ryle's tube feeding refers to giving of feed to a patient through a tube inserted into the stomach through nose or mouth. The purpose is to feed the patient who cannot take oral feed such as patient in unconscious state, following surgery on mouth , throat and esophagus (food pipe).

13. Types of tube / feeding Nasogastric tube (NGT) starts in the nose and ends in the stomach. Orogastric tube (OGT) starts in the mouth and ends in the stomach. Nasoenteric tube starts in the nose and ends in the intestines . Gastrostomy tube is placed through the skin of the abdomen straight to the stomach. Jejunostomy tube is placed through the skin of the abdomen straight into the intestines.

14. Indication Unconscious patient or semiconscious (stroke, which may impair ability to swallow) After certain surgeries of the mouth and throat Patient’s unable to swallow Premature babies, failure to thrive or inability to eat in young children or infants When the patient is unable to retain the food, e.g. anorexia nervosa Cancer , which may cause fatigue, nausea, and vomiting that make it difficult to eat Critical illness or injury, which reduces energy or ability to eat enough nutrients N eurological or movement disorders that increase caloric requirements while making it more difficult to eat GI dysfunction or disease, although this may require intravenous ( IV) nutrition instead

15. Requirement Swab sticks and a small bowel with water - to clean the nostrils. • Mackintosh with cover - to prevent soiling of patient's linen. • Kidney tray and paper bag to collect soiled swabs and gastric content. • Liquid paraffin in small container. • Feed in a container kept in warm water. • 20 to 50 rnl syringe. • Container with feed and glass. • Drinking water

16. Principles / guidelines Give mouthwash frequently to avoid complications of a neglected mouth Maintain intake and output chart accurately Measure and drain the feed (fluid) to avoid blockage in the tube Avoid introducing air into the stomach during each feed. Pinch the tube before the fluid run into the stomach completely from the tube Feeding may be given at intervals of 2, 3 or 4 hours and the amount is not exceeding 150 to 300 ml per feed Observe for complications such as nausea, vomiting, distension, diarrhea, aspiration pneumonia, asphyxia , fever, and water and electrolyte imbalance

17. P rocedure Wash hands thoroughly Place towels around neck in such a way that patients clothing and bed linen are protected Make sure the tube is in stomach before giving feeds Remove spigot. Pinch the tube to prevent air entry. Remove plunger from syringe and connect to tube Keep syringe about 12 inches above patients head. Start feed with small measured amount of water and allow feed to follow slowly and steadily through tube in such a way, that air does not enter tube Do not force fluid, allow to flow by gravity At the end of feed flush tube by pouring small measured amount of water. Remove syringe and replace spigot

18. Procedure Explain the procedure to the patient. • Bring the collected articles to bedside. • Put the patient in fowler's position or sitting position. • Spread mackintosh and towel over the patient's chest. • Clean the nostrils with wet swab sticks. • Wash hands with soap and water and put on gloves. • Take Out the gastric content with syringe, discard it in kidney tray. • Remove the piston by pinching tube near the point of attachment of syringe so that air does not enter into the tube. • Pour the feed into the barrel of syringe, let it flow freely, refill the syringes before it gets empty.

19. After the procedure Remove the Mackintosh and towel Place the patient in comfortable position Replace the articles to utility room, clean it and replace it Record the procedure in nurse’s record sheet and intake and output chart

20. QUESTIONS What are the indications for feeding a patient How many types of feeding method do you know What are the requirement of feeding a patient What guidelines need to be observed when feeding a patient Differentiate types of tube feeding